Provider Demographics
NPI:1275757569
Name:WESTON, REBECCA GOODMAN (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:GOODMAN
Last Name:WESTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4725 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-6218
Mailing Address - Country:US
Mailing Address - Phone:252-659-4500
Mailing Address - Fax:
Practice Address - Street 1:4725 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-6218
Practice Address - Country:US
Practice Address - Phone:252-659-4500
Practice Address - Fax:252-242-8622
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201100749208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics